ESFC – Part 1

Dr. Conway: When I was 19 years old, I began to work for a private company out in California, and they were focused on treatments and programs for children with dyslexia. My expertise is not just the assessment part of that, it really is what do you do when you have figured out what the problem is. Because diagnoses don’t tell you a thing about what to do – the real question to be answered is – how do we change the skills? Can we actually make the weaker skills stronger?

Dr. Conway: Here’s your first question of the day – you are all capable of learning new information we know that learning really means that the brain makes new connections. So the question becomes at what time your life are you going to lose the ability to make new connections. When does it stop happening? What age is that?

[crowd response- never] Is that wishful thinking? She says never – could be true.

Dr. Conway: There actually is one point in time when you are not going to learn anything new. You’re dead. That’s it. When you’re dead, which is the same as never, then you definitely cannot do any new learning. We now know that neuroplasticity; the brain’s ability to wire itself and rewire itself is capable and lifelong.

Dr. Conway: But there are three key principles it applies to anything that you are going to learn. The intensity of the practice – how much time per day do you practice this new activity. Besides intensity, the brain’s learning is really driven by frequency of the practice, which means how many days per week.

Dr. Conway: If I told you – Barbara is going to learn Swahili. She is going to get a free Swahili lesson every Monday for one hour. We say Vicky has won an all-expense paid trip to Africa, she is going to live with the Royal Family for three months, and oh, and one problem though – the African family speaks no English, they only speak Swahili. So Barbara can do a year of Mondays, Vicki could go and do three months and come back and guess who is going to be more fluent – [Vicki]– how come, what’s the differential factor there?

Dr. Conway: It’s intensity, it’s frequency and the explicitness of the instruction That’s the third principle –It’s how explicit – they’re going to teach her the basics first. It doesn’t really help her to know how to say ‘see you later’ if she doesn’t know how to say ‘bathroom’. They want to teach you the more core elements first and the fine-tuned ones later on.

Dr. Conway: So intensity of the instruction, frequency of instruction and the developmental specificity of the instruction are the three key principles that we know that rewires the brain. It doesn’t matter if we are talking about children – elementary school, middle school, high school, college or adult, we’re talking about the brain and it applies across all ages of the population.

Dr. Conway: Medicare even knows this. If you have an injury to your body and you’re in the hospital and so you need speech therapy, or you need PT – guess how often you’re going to get it? Daily, six days a week. Medicare almost mandates it has to happen six days a week – why? Why do we care?

Dr. Conway: What’s going to happen if you get therapy six days a week? You’ll be discharged sooner – they will spend less money and you’ll still have a higher functional outcome. So Medicaid knows that in some of these medical rehab situations, intensity and frequency lead to better recovery and faster recovery.

ESFC – Part 3

Dr. Conway: So part of learning the sounds of our language is part acoustic, part visual, and also part tactile kinesthetic. These 3 sensory systems are supposed to be wiring together. Now at what age do you think these things start to happen.

Dr. Conway: At what age do you actually begin to learn to begin to wire those speech sounds together? How young do you think a child is when they actually start watching your mouth? [polls audience –responses from 3 months to Immediately] Probably it would depend on how fast the visual cuing system develops, but what do parents do to try to help make that happen? How do parents usually talk to kids?

Dr. Conway:“Hi baby!” You shove your face right in the kid’s face, and move your mouth really slow. Did your pediatrician teach you to do that? But again, it’s really important that you do that. Because somebody studied it with a laser eye tracker study to figure out in a sample of kids at what age did they start watching your mouth. And here’s what they found out.

Dr. Conway:These are 4 month olds, 6, 8, 10, 12 months olds compared to adults. These black dots are a laser eye tracker and can tell where the child’s pupil is focusing. At that first age group, where are they focusing? At what age does it shift to the mouth? It’s around 8 months, 10 months, right around that age, past 6 months. Now we are really seeing it here – they’re really looking more at this person’s mouth – that’s eight months of age.

ESFC – Part 4

Dr. Conway: One quick fact check – I’d also like to try to dispel some myths in a talk like this – what causes dyslexia? Why do people have dyslexia? What causes your hair color? What causes your eye color? Guess what causes dyslexia? Genetics. Solid data says its highly genetic – runs in families. It doesn’t mean that you can’t have reading problems that are not due to genetics but those are not dyslexia. That’s an environmentally-induced learning problem.

Dr. Conway: If you’re the child of migrant farm workers and your family moved from school to school to school, and you never get regular education, guess what’s likely to happen to your reading skills? They’re probably not going to be as well developed. But all the research coming out now says language-based learning problems are highly genetic, it’s not a guarantee, it’s a predisposition. They’re more likely to have trouble because there’s family history.

Dr. Conway: The stats right now say if one parent has trouble, the child is eight times more likely to have trouble too. If both parents have some family history, which sometimes it might be hard to do, because most kids, their parents or grandparents – No one was diagnosing dyslexia or learning problems back in their day.

Dr. Conway: They’re the ones who,today, as adults, guess how you can tell that they probably had weaker language skills? What activity do they do that you actually see that can put in front of you that tells you how well their language skills are developed? How many adults read out loud to each other? A lot or a few?

Dr. Conway: Very few. Very few adults actually read to each other, so you’re not going to be able to tell by the adults reading because you usually don’t read aloud to each other as adults. But what do you do that people can see ? It’s not reading, it’s writing, spelling. So most adults who have lingering learning difficulties, you’ll see it more in their spelling because they can’t hide it, they actually have to show it to you. They actually have to spell for you – there’s an ‘a-ha’ moment.

Dr. Conway: But you also may perceive it in their speech – what if an adult says to you: “Let me make myself pacifically clear” – what’s the problem with that? Or they say – “ I’m so flustrated with this university..”And as a child, the parents will say ‘honey, the word is frustrated. And the child will say “I’m saying /flustrated/, mom.” And the mom says “No, no, honey – ,/fru/ /ru/,/ ru/, /frustrated/.”And the child says ‘/Flustrated/, mom! You’re making me /flustrated/!”

Dr. Conway: Why is the child struggling to actually match what the parent is saying? What does that tell you about their language processing system – is it strong, is it weak? It’s a weak system – They’re not perceiving all the sounds that are being produced by the parent. That puts us at risk for having other language problems Because, which system came first – spoken or written? Spoken language develops first. So if you have trouble perceiving words of others, you’re at a higher risk for having trouble and other language problems.

ESFC – Part 5

Dr. Conway: We have all these complications, so which system comes on board first – do you learn how to sound out words first, do you learn how to memorize words first – which one do you think children do first? [sound out] Because, which language skill came on board first?

Dr. Conway: It was that phonology – that you’re perceiving the sounds, being able to say sounds, so that our first reading skill should be – can you sound out words? Can you sound it out using that phonological system? As that system gets strong, then you get better at actually being able to memorize words, that’s where you get to be able to actually drive that sight word knowledge and begin to memorize those words as well.

Dr. Conway: As that grows along, then we know now you need vocabulary. Why? Why do you need vocabulary to read? What’s the purpose of reading? To understand or learn something, but if you don’t know the meaning of words, you’re not going to understand the meaning. You’re not going to get some content from words themselves. We now know that when these three skills are working really well, we’ve built a solid foundation for reading that we want every child to have. And when that happens, our next product is reading fluency. Now they’ll be better able to sound out the words. How do we know this – we studied it.

Dr. Conway: This was another five-year study we did – the question was do we actually have to do fluency training? Do we actually have to do repeated readings, choral readings, chunking, phrasing, there’s all these common practices how to help a child become more fluent in reading. But the other theory was – kids who don’t have reading problems, guess how they get their fluency? What do they do? They just read. So maybe it is that the more efficient this system is here, the better you can quickly sound out words. That’s going to drive that fluency skillset. So we did a study testing it out, and that’s exactly what we found.

Dr. Conway: You can do lots of fluency instruction, but if you actually just made this system become much more efficient, much more automatic, you automatically got fluency even when you didn’t need fluency instruction. It was a natural by-product. Here’s another way to think about that – the average 5th grader who has reading problems – guess how many words they’ll read in one school year? How many words does a 5th grader read in one school year? Counting the same words more than once, give it your best guess. [1000, 2000, 3000]

Dr. Conway: Try 600,000 to a million. Because we’re counting the same words more than once. They might see ‘the’ a thousand times. They might see ‘a’ five hundred times. They’re going to read about 600000 to a million words in one school year. How many words do you think a child who has a reading difficulty and struggles with reading – how many words do you think they’re going to read in a whole 5th grade year?

Dr. Conway: Try 50,000. That’s our current estimates. 50k vs 600k to a million. Which brain is getting more practice? The brain that is doing 600k to a million. We have ten times difference in the practice. That is a phenomenal effect on learning. This is why I started this discussion by talking to you about intensity, frequency and specificity of instruction. We just hit a really key element, which is – how much practice are you getting. If you are only reading ten times fewer words, that, in and of itself is causing a gap to grow in developmental skills.

Dr. Conway: But this isn’t enough – this is not our core reason for reading. What is our real reason for reading? What did you say it was? You are reading to learn what? Content, information. So it’s really about comprehension. Our goal for teaching reading is so that kids can comprehend science, social studies, english, math, literature, that’s our primary goal. But we won’t get here if these skills down here [sounding out/sight words/vocabulary] aren’t strongly developed.

ESFC – Part 6

Dr. Conway: It teaches us that the brain has different areas doing different things. But they are part of a network that is supposed to work together. but you can still have solid reading skills but still have a deficit in comprehension – and these are the students who say to you: Miss, or Professor, or Doctor – I read the chapter three times. And then I’ve got to write it down, and I’ve got to highlight it and talk it over with someone. And what they’re doing is trying to use multiple methods to get some comprehension because their comprehension system is not efficient.

Dr. Conway: There’s only two ways to comprehend – we’ve got two primary systems from a neuropsychological perspective. It’s nice to have something that’s a little bit simpler. If I wanted to explain to you how an MRI takes fMRI pictures of your brain, how many of you have fMRI experience? One?

Dr. Conway: The rest of you, you’re out of luck, unless I explain it to you in a way that’s very clear, very concrete with very simple terminology. That helps you build a kind of movie in your head. If I say ‘the scanner is shaped like a donut. The table slides into the donut. When you’re in the donut, it sends radio waves that knock these cells over and measures how fast it takes the cells to come back up. That tells me where the oxygen is.” If there’s more oxygen here, guess what’s happening to that part of the brain? Oxygen is fuel, That means that part of the brain is doing the work. So if I give you very clear detailed information, you can build a movie, you’ll have better comprehension.

Dr. Conway: We know a large percentage of students don’t make movies in their head when they read. They’re the ones who tell it’s boring, I read, and reread. I read three times. What they’re trying to do is memorize, memorize, memorize all the words they see or hear in the chapter.If I say, for example – sir – seen any good tv shows or movies lately? Any good ones? Did you pay attention? Can you tell me everything every actor and actress said during the movie?

Dr. Conway: Why not? You said you paid attention. Because it’s physically impossible to do that. Your brain cannot remember /word word word/, it doesn’t do it. But could you tell me a story of what the show is about. How come? You didn’t remember the words. He’ll pull back the images, he’ll pull back the movie of what he saw on the screen. He’ll convert it back into words and explain it back to me. This is how our imaging system is supposed to work. But a percentage of people, that imaging system isn’t working, and they’re left with trying to memorize as much information as possible

Dr. Conway: So you can encourage these kids to, surprisingly, listen to an audiobook sometime. try to visualize what the audiobook is talking about. Because kids today get far less practice at making these images than my parent’s generation or grandparent’s generation. Why is that? What’s different? TV, or the video age, we’re not required to make the movie, it’s all being shown to us, sometimes ten times at once. Ten movies at once.

Dr. Conway: But in our parent’s generation or grandparent’s generation, there wasn’t tv – how did they communicate? They actually talked to each other. They actually sat around a table at dinner and discussed the day and used inflection, gesturing and intonation. Or, if they wanted to know the nightly news, guess what they did? How about when they didn’t have tv? Radio. Or they read the newspaper. And on the radio, many times they use sound effects. How did HG Wells scare the bejesus out of so many people just by reading a book on the radio? What did they do? They had so many sound effects and stuff that sounded so real, people’s minds went wild and they thought the Martians were outside their front porch. Because they were making all these movies. So generations ago, we gave people lots and lots of practice making movies – it’s not happening today

Dr. Conway: We have more and more kids who have comprehension problems because they’re not actually being taught how to comprehend. We do tell them look for the main idea, find the subjects, find the direct object, find the plot, the theme, find the sequence of events, but doing that is not as easy if you don’t have the movies in your head. The movies make it far, far easier.

Dr. Conway: One quick question – if I say to you, how many of you have gone the movie theater to see a movie and they picked the wrong actor. He did not match the part for that book. Why is that? Why did your mind think that? When you read the book, what did you do? You pictured Brad Pitt, they chose Dustin Hoffman. It just doesn’t match at all.

Dr. Conway: So you should be making these movies but some folks need more explicit training in doing that. So other of you have taken programs like this mental imagery program and help lay out a series of events and a series of steps that systematically begin to teach mental imagery skills. Because as we train mental imagery skills, we’re more likely to help them know how to make movies, bu8t not only know how to make movies from when they listen, but to take movies and put them back into words.

ESFC – Part 7

Dr. Conway: How does movie making actually relate to writing? Your composition skills? What should the written language do for the reader? It should tell a story – what should it do for the imagery? It should make the movie in their head. But if the story is written in such a way that it goes beginning, and then middle, and then end, an then beginning again and the middle again and then the end again, and this other piece your friend is telling you about, your movie is all over the place and you have no idea what theyr’e trying to say. Or they say “It went down the road by the dog next to the thing under the other stuff” – huh?

Dr. Conway:So it could be because they use such vague terminology. Like say for example I say to you – “the dog went down the road” – Sir, what do you picture for that?

Audience: a dog, going down the road.

Dr. Conway: Ok, do you think your dog looks like mine?

Audience: I’m picturing my dog, as opposed to yours, because I haven’t’ seen your dog.

Dr. Conway: How come? Didn’t I tell you the dog went down the road? Shouldn’t we have the same picture?

Audience: Perhaps of a dog, but not a specific dog.

Dr. Conway: So what if I said – “the small white poodle went down the brown dirt road next to a green grassy field at sunset”? What has that done to your movie now?

Audience: More specific.

Dr. Conway: My words should be dictating what you visualize. If I want to clearly communicate with you, I’m using more accurate nouns, adjectives, adverbs; I’m putting in more detail to help build the movie for you. How does that relate to my writing? When I write it, I should be writing with more detail as well. If you have a very clear movie in your head, it’s much easier to take that movie and convert it into writing. So part of a program like this is designed to do that. You first have to do it at what level – written language or spoken language? This is the same scenario. When we’re talking about comprehension, you have to deal with oral language first, to be able to talk about it in a systematic, clear, concise, very detailed fashion before I can actually go to writing it. Because what does writing have that spoken language doesn’t? What demands does it put on your brain that spoken language has none of those demands at all?

Audience: Grammar, Structure, Sequencing, Spelling.

Dr. Conway:How about punctuation? Capitalization? Comma usage? There’s all these extra rules of written language that have no bearing whatsoever on spoken language. I hate to tell you –but you speak in agrammatic sentences. You speak in incomplete sentences – that’s horrible, isn’t it? But that is our acceptable spoken language. It doesn’t have to be a complete sentence, it doesn’t always have to have a subject and a verb.

Audience: When you read something, aren’t you essentially converting back into spoken word?

Dr. Conway: Essentially you are, but it should be converting back to spoken and into a movie. Unless it’s something you already know about. Like say, for example, say you’re an architect. And I want to describe to you Frank Lloyd Wright buildings. But you’ve already studied Frank Lloyd Wright buildings for too many days. So if I talk about it, you don’t really need to visualize it, because you know that information so well, it’s part of your linguistic knowledge base. So there’s a big theory that’s been worked on for about six decades now.

Dr. Conway:This one researcher has worked on this theory called the Dual Coding Theory. What is says is when you’re comprehending, you’re using one of two systems. It’s the imaging system, which is that imagery, or it’s that locution system, which is language. Physically we call it the right side versus the left side because, predominantly in studies when you’re making movies, the right side is doing more of the activity. Predominantly when you’re doing language – what’s happening then? It’s the left side of the brain doing most of the work. So, you’re supposed to be using those two systems interchangeably if they both are strong and work well. If they’re not strong and they don’t work well, you’re relegated to just using one or the other, because you don’t know how to use both.

ESFC – Part 8

Dr. Conway: When you look at brain activity, here’s the brain activity for someone who doesn’t have any reading problems. What do you notice about this brain? Here is the right side, here is the left side. Which side has more activity?

Audience : Left

Dr. Conway: That’s the typical picture of someone who doesn’t have any reading problems. The left side is supposed to do most of the work. So it’s supposed to have strong activity. Here’s a typical model that says here’s some of the major areas of the brain that are involved in these language skills. You’ve got phonological perception happening in here, you’ve got the auditory being connected to the motor, because these are some fibers that run all the way to the front, this is the part that actually moves your mouth, helps your mouth say words. This is the part back here that plays a big role in meaning. But no, the brain is not really yellow, blue and green; and no, it’s not that simple that one part has one function, it’s really much more of a distributive network. This is an fMRI meta-analysis, which means it’s twenty-five different MRI studies combined together. You see the blue dots are where their brains were being active when they’re being asked to make judgments about phonology. The green dots they are asked to make judgments about sentences and syntax, the red dots are judgments about meaning. Can you find that one meaning area now? Can you find that one phonology area, that one blue area that is just perceiving sounds? Doesn’t exist, because the brain’s actually distributing networks of information.

Dr. Conway: It’s supposed to be spread across this language cortex. Now, it isn’t region specific, so it’s not all back here, and there’s not much activity up here, it’s right through this primary language and speech cortex right here.

Dr. Conway: So when the brains’ working efficiently those parts are supposed to be doing most of the work.So again, here’s that normal reading child, strong activity on the left side. What do you think the brain activity looks like in a child who has dyslexia and is struggling to read?

Dr. Conway:Here’s the picture –what do yo use now? Where’s the activity for the child who is struggling with reading and language – right side or left side? Right side. Much more activity over here, much less activity here – which tells us this the part that’s supposed to be hardwired for language, but this child is trying to use this part, because this part is less efficiently wired. And I’m saying that literally, we literally have evidence to say it’s wired less efficiently and I’ll show you some more data about that. But here’s the big picture – the activity patterns. More activity in the right, the kid’s brain is trying the best it can to do the reading, but the right part is not really supposed to be doing reading. The right is more geared towards music, mathematics, judging pitch and tone, emotional connotation in your voice.

ESFC – Part 9

Dr. Conway: What percentage of people in juvenile justice have reading problems – 80 percent. What percentage of high school dropouts have reading problems – 80 percent again. And it probably varies some by area to area. What percentage of people in prison already incarcerated, have reading problems or literacy problems? Again, it’s at least 80 percent. We set these people on a trajectory of difficulty and more likely, failure, but not fixing these skills as soon as possible. Because in this society today, you really better be able to read and deal with language as we are a very language-rich society.

Dr. Conway: So by definition, dyslexia means ‘trouble with words’. It’s genetic, it’s lifelong. Our treatments are highly successful, but they’re not going to change your genetic structure. It may rewire the brain, but it doesn’t actually change the genes. Sometimes your reading comprehension is actually better than word reading and you may have co-occurring challenges. 50-70% of people with dyslexia will also have ADHD. There may be behavioral problems because of the frustration they’ve experienced.

Dr. Conway: There may be sensorimotor problems, which means when many of these kids are given a pencil to write, they don’t use a tripod grip., they grip it like this or like this [overhand and club grips] What they’re doing is turning writing into a gross motor activity. They’re moving the whole arm, this is a fine motor act. That wiring that I showed you was inefficient in the brain – that was that language cortex – what I forgot to point out was right above that, that’s your fine motor skill cortex. It’s fine motor skill for the fi ngers, and guess what other area? The mouth. Which we think leads to why they have decreased sensory awareness here, the tactile kinesthetic feeling isn’t as strong, because that’s an area of the brain that’s shown to have less efficient wiring. When that happens, it’s more difficult to help improve their skils.

Dr. Conway: What dyslexia is not – it’s not a visual problem. You don’t see words backwards. You’ll never see a dyslexic person look at the word ‘the’ and say ‘eht’. Doesn’t happen. That was a myth. It’s still being perpetuated today and completely unfounded by science. It’s not due to lack of intelligence. In my online company where we do online tutoring, all across the United States, one of my current clients – guess what is profession is? He’s a heart surgeon? Guess what he can’t do? Read or spell out words. And he made it through med school. He is a literal heart surgeon.

Dr. Conway: And what happened is, his kids started catching his reading errors, and he was embarrassed by that. He was like ‘’I’m a heart surgeon, I should be able to read better than my five and six year olds.” So he sought treatment, he sought help. He’s not the first physician I’ve treated. In thirty years, trust me, I’ve treated a lot of heart surgeons, neurosurgeons, hand trauma surgeons, people who’ve had more struggles. Guess what? You’ll see more dyslexia in surgeons than you will in pediatricians – why is that? To be a pediatrician, what might you be better able to do? Talk to people. What are surgeons not known for? Not great talking skills or bedside manner – the nurses do that. But they’re more skilled with the fine motor skills when they come in to do the surgery. But they’ve chosen a profession that works to their strengths, not their weaknesses.

Dr. ConwayYou’ll see more dyslexia in architects and engineers – how come? Those are visual-spatial activities, not as much language. Some people with dyslexia have better visual-spatial skills but when we do large-scale studies, not all of them. Many are just as impaired in their visual-spatial skills as they are in their language skills. The only way we know is when we test them. Once we test them, we know how to treat both those skills and make them stronger and helps us figure out what to do about it.

ESFC – Part 9

Dr. Conway: How about an adult? How about a 17-year old? He comes in – scored in the 70’s. We were actually able to move all those skills up to 115, 97, 76. This boy took four months time. Because he had a lot more problems. He had attention problems, comprehension problems, visual-spatial tracking problems and phonological problems and we had to work on all of it. But when we did that, we saw these skills systematically move up into at least his IQ range, which is his goal of targeted functional abilities.

Dr. Conway: Here’s his other word-reading skills. Even his written expression, because we did a training program for written expression as well, is solidly in the average range. Here’s his writing. But if I had not told you ahead of time and said to you, what grade level is this kid who is writing this, you would not have told me “eleventh grade”, I guarantee it. But this is how well he writes as an eleventh grader.

Dr. Conway: He was asked to write an essay with three points – give me the reasons for or against putting PE in school. And he writes:

“Dear Editor – I think every child should have PE. It’s fun but healthy too. I know some children might not like it, but it would help them blow some steam off too. So maybe they wouldn’t be so wild in the classroom.”

Dr. Conway: Not qualified for eleventh grade writing. He is not on track for a standard diploma, he is on track for a special diploma because he’s fallen so far behind. Guess what his mother does for a profession? Certified ESE Reading Specialist. And here’s her own son, her last child, whom she spent all her time trying to help. He’s severely dyslexic, as well as ADHD, as well as having some comprehension and sensorimotor problems, and nothing she has learned from strategies or compensatory skills.

Dr. Conway: Here’s what he could do four months later. Now what I didn’t tell you was this was a timed test. He only got ten minutes to write and had no help. No notes to look at, just write. He’s what he could do, four months later, with the same prompt. Look and see what’s different about his structure:

“Dear Editor, may name is Jon. I think everyone should be required to take PE. Pe is a great exercise each day. Not everyone should be in marathon condition, but I think it would keep kid somewhat healthy and at school more. Also, kids sit in the classroom about seven hours a day. We need PE to wake us up for class. Sometimes classes get boring. PE is a way to have fun and help us stay awake in class. In conclusion, PE will bring kids to school, help make better grades and is just a little fun each day.”

Dr. Conway: How’s he doing now? We went back and did credit retrieval. He went back and got on track for a regular high school diploma. We got a letter from his mother two years after he finished treatment from us – he is not on track for a college degree and he finished his Associate’s Degree. He had the intelligence all along, yet the deficits were holding him back. When you actually change those foundational skills, you change the higher-order functional skills as well. And you change the trajectory of what they can do.

Dr. Conway: When he was given it untimed (this is not his handwriting, by the way) then he wrote a five-paragraph essay about why farming is important to the United States economy. He now knew how to use imaging to organize the information, he now understood the grammatical structures, he now had better phonological skills, all because we did a really intensive treatment program to really build those skills in four months time.

About Us

Founded by Developmental Behavioral Pediatrician Dr. Ann Alexander, and currently owned and operated by Dr. Tim Conway, The Morris Centre Trinidad and Tobago has over 27 years of experience